Factors Associated with Breast Cancer Awareness in Thai Women

Background: Breast cancer is the most common cancer in women worldwide. In south-east Asia, both the incidenceand mortality rates of breast cancer are on the rise, and the latter is likely due to the limited access to large-scalecommunity screening program in these resource-limited countries. Breast cancer awareness is an important tool whichmay, through increasing breast self-examination and the seeking of clinical examination, reduce breast cancer mortality.Investigating factors associated with breast cancer awareness of women is likely to help identify those at risk, andprovide insights into developing effective health promotion interventions. Objective: To investigate factors associatedwith breast cancer awareness in Thai women. Methods: A cross-sectional sample of Thai women aged 20-64 yearswas collected during August to October, 2015 from two provinces of southern Thailand (Surat Thani and Songkla). Aquestionnaire including the Breast Cancer Awareness Scale along with demographic characteristics was administeredand Proportional Odds Logistic regression was then used to investigate factors associated with breast cancer awareness.Results: In total, 660 Thai women participated in this study. Factors most often associated with the various breastcancer awareness domains were age and rurality. While rural women had poorer knowledge of breast cancer signs andsymptoms, they also had lower levels of perceived barriers and considerably better breast cancer awareness behaviors.Conclusion: Despite lower knowledge of breast cancer risk factors and no evidence of better knowledge of signs andsymptoms, we found rural Thai women had considerably better breast cancer awareness behavior. This may be due tothese women’s lower levels of perceived barriers to breast cancer screening services. Indeed this suggests, at least inThai women, that interventions aimed at lowering perceived barriers rather than enhancing disease knowledge maybe more successful in engaging women with breast cancer screening services and increasing breast self-examination.     

Gail Model Underestimates Breast Cancer Risk in Thai Population

Background: The Gail model is the most widely used method for breast cancer risk estimation. This model hasbeen studied and verified for its validity in many groups but there has yet to be a study to validate the Gail model in aThai population. This study aims to evaluate whether the Gail model can accurately calculate the risk of breast canceramong Thai women. Methods: The subjects were recruited from the Division of Head, Neck, and Breast Surgery,Department of Surgery, Siriraj Hospital. The patients attending the division were asked to enroll in the study andcomplete questionnaires. Gail model scores were then calculated. Relationships between parameters were examinedusing the Pearson’s chi-square test, Fisher’s exact test, and independent-samples t-test. Results: There were 514women recruited. Age, parity, age at first-live birth, and history of atypical ductal hyperplasia (ADH) were significantrisk factors for breast cancer. The 5-year and lifetime risk score for breast cancer calculated by the Gail model werenot significantly different between the patient and the control subjects. The proportions of the subjects with lifetimerisk ≥20% were significantly higher in breast cancer patients (p=0.049). Conclusion: The Gail model underestimatedthe risk of breast cancer in Thai women. Calibration of the model is still required before adoption in Thai population.     

High Frequency of KRAS Codon 146 and FBXW7 Mutations in Thai Patients with Stage II-III Colon Cancer

Background: KRAS, NRAS, and BRAF gene mutations are the most clinically relevant and frequently reported incolorectal cancer (CRC). Although data on these genes are frequently reported in several counties, data specific to thesegenes among Thai population are scarce. The aim of this study was to investigate and identify molecular alterationsassociated with colon cancer in Thai population, and to determine the impact of these genetic aberrations on clinicaloutcome. Methods: DNA from 108 archived formalin-fixed, paraffin-embedded (FFPE) tissue samples that histologicallyconfirmed adenocarcinoma of stage II-III colon cancer between 2010 and 2012 at Siriraj Hospital (Bangkok, Thailand)were extracted. Gene mutational analysis was performed by next-generation sequencing (NGS) using an OncomineSolid Tumor DNA kit (Thermo Fisher Scientific, Inc., Waltham, MA, USA). Results: A total of 22 somatic genemutations were detected. The mutation frequency observed in KRAS, NRAS, BRAF, PIK3CA, and FBXW7 mutationswas 47.2%, 1.9%, 1.9%, 12%, and 14.8%, respectively. KRAS mutation codon 12, 13, 59, 61, 117, and 146 mutationswere identified in 29.6%, 8.3%, 1.8%, 0.9%, 0.0%, and 8.3%, respectively. KRAS Exon 4 had better DFS comparedwith Exon 2 and 3. Conclusions: This study is the first to comprehensively report hotspot mutations using NGS in Thaicolon cancer patients. The most commonly identified gene mutation frequencies among Thai patients (KRAS, NRAS,BRAF, TP53, and PIK3CA) were similar to the gene mutation frequencies reported in Western population, except forsubgroup of KRAS codon 146 and FBXW7 mutations that had a slightly higher frequency.     

Questionnaire Validation of Colorectal Cancer Literacy Scale among Thai People in Northeastern Thailand

Background: Colorectal cancer is an important public health problem worldwide. Although progress in screeningand treatment has considerably improved the prognosis in the developed world, in developing countries colorectal cancermortality rate remains relatively high. Colorectal cancer screening literacy is an important initial step in overcoming thisproblem. Development of a validated assessment instrument is therefore important for implementation of appropriatehealth education programs to facilitate early detection. Objectives: This study focused on generation and validation ofa colorectal cancer screening literacy scale for Thai people in northeastern Thailand. Methods: This methodologicalstudy was carried out in two phases: (1) literature reviews and semi-structured interviews were used to select items,then the content and face validity were checked; and (2) a confirmatory factor analysis (CFA) was conducted to testconstruct validity and reliability. A self-administered questionnaire was used to collect data from Thai people aged 50-65 in June 2017. Results: For the total of 400 participants who responded (response rate 100 %), the age ranged from50 to 65 years old (mean = 57.3, SD = 4.616). The colorectal cancer screening literacy scale was designed to include6 domains and it was shown to have good internal consistency, and CFA demonstrated the model to fit data adequately(Chi-squared/degree of freedom = 1.079, p = 0.061, CFI = 1.00, GFI = 0.93, AGFI = 0.91, RMSEA = 0.014 and SRMR= 0.036). The final version of its, consisting of 57 items across the 6 domains covering key aspects of colorectal cancerscreening literacy, demonstrated good psychometric properties for this population. Conclusions: Use of the colorectalcancer screening literacy scale in Thai people could lead to improved educational programs for optimizing colorectalcancer screening.     

Hematological and Molecular Characterization of a Novel Hb A2 Variant with Homozygous α-Thalassemia-2 in a Southern Thai Individual

We report here the hematological and molecular features of a novel δ-globin chain variant found in a Southern Thai woman. Her complete blood count was as follows: red blood cell (RBC) count 5.90?×?10¹²/L, hemoglobin concentration (Hb) 12.6?g/dL, packed cell volume (PCV) 0.41?L/L, mean corpuscular volume (MCV) 69.5 fL, mean corpuscular Hb (MCH) 21.4?pg, mean corpuscular Hb concentration (MCHC) 30.7?g/dL and RBC distribution width (RDW) 13.1%. The blood smear demonstrated microcytic hypochromic RBCs suggestive of thalassemia trait. Hemoglobin analysis identified Hb A₂?+?Hb A₂-Kiriwong (2.4%) and Hb F (0.1%) on high performance liquid chromatography (HPLC). To characterize the α-thalassemia (α-thal) genotype, common α-thal-1 and α-thal-2 alleles were characterized by multiplex gap-polymerase chain reaction (gap-PCR). The results revealed homozygous α-thal-2 (–α^3.7/–α^3.7) in this case. DNA sequencing showed the presence of a novel δ-globin gene mutation [δ77(EF1)His→Arg; HBD: c.233A>G] that we named Hb A₂-Kiriwong for the village from where the proband lived. In summary, the presence of microcytic hypochromic RBCs in this case was likely the result of the homozygous –α^3.7 (rightward) deletion and was not affected by this Hb A₂ variant.     

Development of a Breast Cancer Awareness Scale for Thai Women: Moving towards a Validated Measure

Background: Breast cancer is a major health problem among women around the world. Recent developments in screening and treatment have greatly improved the prognosis of patients with breast cancer in developed countries. However, in developing countries breast cancer mortality remains high.Breast cancer awareness is a first and important step in reducing breast cancer mortality. The development of a validated instrument to measure breast cancer awareness is crucial for the understanding and implementation of suitable health education programs to facilitate early deletion and minimize mortality. Objective: The objective of this study was to develop an instrument for the assessment of breast cancer awareness in Thai women. Materials and Methods: This methodological study was conducted in two stages: (1) literature searches and semi-structured interviews were conducted to generate items of the breast cancer awareness scale (B-CAS) which were subsequently examined for content and face validity, and (2) an exploration of the factor structure of the resulting instrument and an examination of its reliability. Data were collected using a self-administered questionnaire in Thai women aged 20-64 in August, 2015. Results: A total of 219 women (response rate 97.4 %) participated in this validation study. The B-CAS contains five domains with 53 items on breast cancer awareness: 1) knowledge of risk factors, 2) knowledge of signs and symptoms, 3) attitude to breast cancer prevention, 4) barriers of breast screening, and 5) health behavior related to breast cancer awareness. Items with a content validity index < 0.80 were excluded, and factor structure for the remaining items reflected the hypothesized five factor model. The scales based on all retained items was shown to have strongly internal consistency reliability (Cronbach’s α=0.86). Conclusions: The B-CAS provides good psychometric properties to assess breast cancer awareness in women. It can be used to examine breast cancer awareness in Thai women and it could lead to the development and evaluation of suitable educational interventions for raising breast cancer awareness. Future research should focus on further validating the B-CAS including an assessment of construct and criterion-based validity.     

Screening for pancreatic cancer in familial high-risk individuals: A systematic review

AIM: To analyze the benefits and harms of pancreatic cancer screening in familial high-risk individuals (HRIs).METHODS: Studies were identified by searching PubMed, EBSCO, ClinicalTrials.gov and the Cochrane database from database inception to June 2014. We also obtained papers from the reference lists of pertinent studies and systematic reviews. English-language trials and observational studies were searched. The key words used as search terms were “screening” and “surveillance”. Cost-effectiveness, diagnostic rate, survival rate, mortality and adverse events were the outcomes of interest. Age, sex, lifestyle and other confounding factors were also considered. However, anticipating only a few of these studies, we also included observational studies with or without control groups. We also included studies concerning the anxiety associated with pancreatic cancer risk and other psychological changes in familial HRIs. We extracted details on study design, objectives, population characteristics, inclusion criteria, year of enrollment, method of screening, adjusted and unadjusted mortality, cost-effectiveness and adverse events from the included studies. Studies were assessed using the Reporting of Observational studies in Epidemiology (STROBE) checklist.RESULTS: Sixteen studies on pancreatic cancer screening were included. Five studies included control groups, nine were observational studies without control groups, and the other two studies investigated the worry associated with pancreatic cancer risk. We found that pancreatic cancer screening resulted in a high curative resection rate (60% vs 25%, P = 0.011), longer median survival time (14.5 mo vs 4 mo, P < 0.001), and higher 3-year survival rate (20% vs 15.0%, P = 0.624). We also found that familial HRIs had a higher diagnostic rate of pancreatic tumors than controls (34% vs 7.2%, P < 0.001). In patients who underwent regular physical examinations, more stage I pancreatic cancers were observed (19% vs 2.6%, P = 0.001). In addition, endoscopic ultrasonography, which was the main means of detection, diagnosed 64.3% of pancreatic cancers. In comparison, endoscopic retrograde cannulation of the pancreas, magnetic resonance imaging, and computed tomography diagnosed 28.6%, 42.9%, and 21.4%, respectively. For mass lesions, instant surgery was recommended because of the beneficial effects of post-operative chemotherapy. However, in patients with intraductal papillary mucinous neoplasms, we did not find a significant difference in outcome between surgery and follow-up without treatment. Moreover, pancreatic cancer screening in familial HRIs had a greater perceived risk of pancreatic cancer (P < 0.0001), higher levels of anxiety regarding pancreatic cancer (P < 0.0001), and increased economic burden.CONCLUSION: Pancreatic cancer screening in familial HRIs is associated with a higher detection rate and longer survival, although screening may influence psychological function and increase the economic burden.     

Marital status and stage at diagnosis of cutaneous melanoma: results from the Surveillance Epidemiology and End Results (SEER) program, 1973-2006

BACKGROUND:

We evaluated the effect of marital status on risk of late‐stage cutaneous melanoma diagnosis.

METHODS:

Information about melanoma patients was obtained from Surveillance Epidemiology and End Results (SEER), 1973‐2006. A multivariable logistic regression model was used to estimate relative risks of late‐stage disease at diagnosis.

RESULTS:

After exclusion criteria, 192,014 adult melanoma patients remained for analyses. After adjustment for age, race, year of diagnosis, tumor histology, anatomic site, socioeconomic status, and SEER site, the relationship between estimated risk of late‐stage melanoma diagnosis and marital status was dependent on sex (P < .0001 for interaction). Although unmarried patients had a higher risk of being diagnosed at a late stage among men and women, the magnitude of the effect varied by sex. Moreover, among married, single, and divorced or separated patients, men had more than a 50% increase in risk of late‐stage diagnosis when compared with women. Widowed men and widowed women, however, were not statistically different in their stage at diagnosis.

CONCLUSIONS:

Results from this study are important and may be used by clinicians and public health practitioners interested in increasing the proportion of melanoma patients diagnosed at an early stage through screening, perhaps by specifically targeting unmarried individuals in addition to having broad‐based skin cancer prevention programs. Cancer 2011. © 2010 American Cancer Society.     

Association of incompleteness of the anterior part of the circle of Willis with the occurrence of lacunes in the basal ganglia

Background and purpose: This study investigated whether incompleteness of the anterior part of the circle of Willis affects the occurrence of lacunes in the basal ganglia. Methods: One thousand and seventy‐seven healthy individuals examined by magnetic resonance (MR) imaging and MR angiography were divided into eight subgroups according to our new classification. Results: Logistic regression analysis demonstrated that healthy individuals with incompleteness of the anterior circle of Willis had significantly higher frequency of lacunes [odds ratio (OR): 2.121, 95% confidence interval (CI): 1.477–3.108; or OR: 2.46, 95% CI: 1.377–4.384 in cases without or with fetal type posterior communicating artery, respectively] and higher numbers of lacunes (P < 0.001 or P < 0.001 in cases without or with fetal type posterior communicating artery, respectively) compared to patients with complete circle of Willis. Conclusions: Incompleteness of the anterior part of the circle of Willis significantly affected the occurrence of lacunes.